Provider Demographics
NPI:1063505949
Name:ONSLOW AMBULATORY SERVICES, INC
Entity Type:Organization
Organization Name:ONSLOW AMBULATORY SERVICES, INC
Other - Org Name:INTERNAL MEDICINE AND PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-577-2533
Mailing Address - Street 1:241 NEW RIVER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-5928
Mailing Address - Country:US
Mailing Address - Phone:910-577-4753
Mailing Address - Fax:910-577-2575
Practice Address - Street 1:31 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-346-5016
Practice Address - Fax:910-577-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
NCAS0039261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89013R6Medicaid
NC013R6OtherBC VIRGINIA
NC013R6OtherBC VIRGINIA
NCCH0661Medicare PIN